Summary

Heterosexual non-Hispanic black women in the United States are far more affected than women of other races or ethnicities by human immunodeficiency virus (HIV). SisterLove, Inc., a community-based organization in Atlanta, Georgia, responded to this disparity early in the epidemic by creating the Healthy Love HIV and sexually transmitted disease (STD) prevention intervention in 1989. Since then, SisterLove has been delivering the intervention to black women in metropolitan Atlanta.

This report describes successful efforts by SisterLove, Inc., to develop, rigorously evaluate, and demonstrate the efficacy of Healthy Love, a 3-4-hour interactive, educational workshop, to reduce HIV- and sexually transmitted disease-related risk behaviors among heterosexual black women. On the basis of the evaluation findings, CDC packaged the intervention materials for use by service provider organizations in their efforts to reduce HIV disparities that affect black women in metropolitan Atlanta, the South, and the United States. This report also describes initiatives by SisterLove after the efficacy study to increase the potential effectiveness and reach of the Healthy Love intervention and further address HIV-related disparities that affect black women. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that might be effective in reducing HIV-related disparities in the United States.

The results of the randomized controlled efficacy trial highlight the potential of culturally tailored, interactive group intervention efforts to reduce health disparities. CDC's support for evaluating and packaging SisterLove's intervention materials, and making the materials available (www.effectiveinterventions.org) for use by service provider organizations, are important contributions toward efforts to address HIV-related disparities that affect black women.

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Introduction

Heterosexual non-Hispanic black women in the United States are far more affected than women of other races or ethnicities by human immunodeficiency virus (HIV).1 The greatest source of risk for HIV infection for U.S. black women is unprotected sex with a male partner.1 In 2010, non-Hispanic blacks constituted 12.6% of the U.S. population but accounted for 45% of all new HIV infections.2,3 Of women aged ≥13 years, black women accounted for 63.5% of new infections and had a reported HIV infection rate 15 and three times as high as those for white women and Latina women, respectively.2 An estimated 85% of black women who are infected with HIV are infected during heterosexual sex; the remaining 15% are infected through injection drug use.1

The South accounts for approximately one third of the U.S. population and for half of newly reported HIV infections.4 During 2005-2008 in the South, black women accounted for 71% of new HIV diagnoses among all women.4 In Georgia, blacks accounted for 30% of the state's population and for 74% of all HIV cases in 2009.5 Black women in Georgia have been particularly affected; in 2012, they accounted for 75% of all women in the state who were living with HIV.6

Among the social determinants and situational factors that can contribute to HIV/AIDS among black women are poverty, limited partner availability because of high incarceration rates and death among black men, and sex-based power differentials within couple relationships that can limit women's ability to negotiate HIV protective actions with their regular male sex partners.7 Effective, culturally appropriate interventions are needed to reduce HIV-related risks among black women.8

Community-based organizations (CBOs) are uniquely placed to understand the circumstances of the communities of color and other high-risk populations they serve. In addition, these organizations can potentially translate their knowledge, credibility, and cultural competence into effective HIV prevention initiatives, thereby addressing HIV disparities that affect these populations.9,10

Background

Actions by the Atlanta-based CBO, SisterLove, Inc. (http://sisterlove.org), exemplify such a community-based effort. Responding early to the disproportionate effects of the epidemic of HIV/AIDS on heterosexual black women and the lack of prevention resources for this population, SisterLove created the Healthy Love intervention to prevent HIV and sexually transmitted disease (STD) infection in 1989. Since then, SisterLove has been delivering Healthy Love to preexisting social groups (e.g., sororities, churches, and friendship circles) of black women in metropolitan Atlanta. CBO staff members describe Healthy Love as an intervention that "makes house calls" because it is delivered to groups of women at locations they select.

This report describes 1) efforts by SisterLove, to develop the Healthy Love Intervention; 2) previously published findings11 demonstrating the efficacy of the Healthy Love intervention for reducing HIV/STD-related risk behaviors among heterosexual black women; 3) CDC support for packaging the intervention and making it freely available to the public; and 4) subsequent initiatives by SisterLove to increase the potential effectiveness and reach of Healthy Love, further address HIV-related disparities that affect black women, and make the intervention accessible to other high-risk populations.

CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that might be effective in reducing HIV-related disparities in the United States. Criteria for selecting this program are described in the Background and Rationale for this supplement.12

History

To learn from community-based HIV prevention practices and make effective practices available more broadly, CDC initiated the Innovative Interventions Project in 2004.13 The project aimed to identify and rigorously evaluate culturally appropriate HIV prevention interventions that CBOs had developed with substantial community input and were delivering to minority populations at high risk for HIV infection in their communities and that had shown some promise of being effective but had not been evaluated because of funding constraints. Before the project began in 2004, CDC had identified only one efficacious HIV prevention intervention designed specifically for black heterosexual women.14 The other interventions for black women targeted women at higher risk for acquiring or transmitting HIV, including crack cocaine users,15,16 patients at inner-city family-planning or primary-care clinics,17-19 and women with HIV/AIDS.20 In 2004, the Innovative Interventions Project supported SisterLove to evaluate the efficacy of its Healthy Love intervention in a randomized controlled trial.

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